Of course that assumes that it really is obesity that causes my arthritis. When everyone (every single person I know and I have medical records on several ancestors) has it regardless their weight... I'm not so sure obesity is the cause.

Sure, I'm fat. I've had the bariatric surgery to "cure" it and it didn't work. It's caused health problems of its own relating to malnutrition and malabsorbtion, not to mention surgeries to repair the original surgery's failures.

I'd likely be near the same weight but much healthier if I'd never had the surgery and never went on a diet.

But... of course, my mild high blood pressure is due to my weight. To what do you attribute my near perfect cholesterol and blood sugar readings?

Could it be that same heredity that causes my arthritis?

Not all diseases (even depression) are caused by something that someone purposely does or does not do.

Two things are driving up the cost of health care:

1) treatments and technology that were not available 20 years ago.

2) layer upon layers of bureaucratic bullshit that did not exist 20 years ago.

Not true. The politically well-connected will continue to receive high-quality care.

Really? In the USSR the Bolsheviks instigated a purge of the kulaks, but then a NEW ruling class of Bolsheviks emerged who had the best of everything, dammit.... Even Communism doesn't work out for the little guy!

The discussion begins with the statement, "Our health care system is in crisis and needs fixing."

How do you even have a rational discussion when you're presented with an extremely debatable fallacious and I dare say partisan conclusion offered as opening premise?

I pay through the nose for insurance. I have more health insurance than I care to use but even the meager portion I do use is a total drag. Insurance companies can be complete bastards. The last one, who I changed this year and who must remain nameless but whose initials are United Health Care, came between me and my primary care physician so heavily that I avoided primary care altogether. I became sick and tired of all UHC's correspondence telling me what I must do for them for things to work and what they would not pay for.

My housekeeper's boy had an accident typical of the sort boys get up to. I asked my housekeeper if she had insurance. She said for herself, yes, through her employer, but not for her kids. That would amount to $400 a month additional she could not afford. He was bleeding a lot near one eye, freaked them both out so she took him to hospital. The boy took a few stitches to patch. He's fine. Turns out, it could have been managed at home, but they didn't know that while the boy was bleeding so profusely, and so close to his eye, she didn't risk treating at home. She didn't take the boy to a neighborhood clinic where he could have been patched up quickly and less expensively, instead she rushed him to emergency and now will face the bills. As to her own insurance, I do not have a good answer for her. I would prefer her kids all be insured. I could imagine a better way than emergency for everything that happens that seems beyond home remedy. I believe modern life is just too complex for some people to handle and the costs are so high they need their freedom exchanged for security. Even if they had insurance, then that complexity would be too much to handle. So this rational argument about stellar health care being exchanged for freedom and sub-standard health care loses to the masses of people with no health care at all and an inability to cope with the complexities of modern life.

But let's be frank, this isn't about health care. As always, it's about votes and about control and about the appearance of caring. If these politicians foisting this on us actually did care then they'd make it possible to enable everyone to acquire real insurance and they'd restrict outrageous settlements against health care providers driving up their insurance and out of the business, and they would regulate insurance companies more closely and carefully.

Out of curiosity, how is it remotely constitutional for congress to mandate that every person have health insurance?

* * *

Chip:

UHC is the worse health insurance I ever had. They denied almost all non-trivial claims forcing me to resubmit them (the other trick was to suddenly lose record of being a customer.) Since then I've had good to great insurance. During all this, my family and I had a fantastic set of doctors and excellent hospitals.

One hopes a socialist plan wouldn't go that far. I think it is possible to have a socialized system without requiring equality. We already have medicare and medicaid, laws that prevent denial of service in certain cases and force insurance companies to cover lousy risks, and laws that require certain companies to provide healthcare options to their employees. That's already pretty socialist.

Chip, that sounds like the sort of situation that the new clinic ideas for Walgreens and Walmart might be able to help. Staffed by nurses and nurse practitioners and pay cash... how much does it cost, really, to spend a few minutes to have someone with some experience to clean and sterilize and put a bandaid on it and tell you if it's serious or not?

But if it's not *cash* based, then you've got all the insurance claims to process which have to pay the salaries of that many more people full-time... and government claims are no different.

Part of what people want is the easy urgent care availability and shot clinics and the place to go when you know what is wrong and what drug you need. And it *ought* to be easy, but government free clinics would be like government doing *anything*... can we all say DMV? I knew we could.

The retail clinics such as what Walmart was/is suggesting would charge for having someone look at a head wound and put a bandaid on it... but not anywhere near what an emergency room costs.

Facilitating that sort of basic care by making sure that the legal hurdles are small and reasonable would cost next to nothing.

"As a thought experiment, what if government-run health care were high quality? Would that make it okay?"

Do we need a thought experiment?

We've got military health care as an example. It's fabulous. In so very many ways it's utterly exceptional.

But it's got it's quirks. It's got it's rules.

I had two babies with the Air Force and not a single complaint... but then, it didn't bother me at all not to get to choose my doctor. Honestly, I liked the way they did it. There was a staff, you made an appointment, and you saw the next available doctor or nurse midwife on the list. Different person almost every time. (Military OB/GYN departments are huge because everyone is in their prime reproductive years.) And then... when I went into labor and went to the hospital the doctor on duty (and a host of boys way too young to have their illusions destroyed) delivered whomever was ready to deliver.

The theories and methods were cutting edge, really, and I was shocked with later civilian experiences that the civilian hospital was sooo bad when it came to post-birth treatment of *me* and stupid obsolete behavior with my baby... like feeding her freaking sugar water from a bottle...

But there, too... you didn't have a choice. At the time drugs and epidurals were out... so you didn't have the option.

My husband had herniated disks and major back surgery that took 14 days in the hospital for recovery. He had a fabulous neuro-surgeon... because they had one on staff at Clark, AB. We arrived one day, he went to see the doctor, and they had him in surgery before he even in-processed to his squadron.

BUT... that was after an entire year of one three day stint in "quarters" after another, and constant pain killers and muscle relaxants. And being taken *off* quarters because otherwise the doctor would have to refer him to a specialist, and then, three days later, being on quarters again. He never had an MRI, never had a CAT scan... because those were the things that would have to happen if he was on quarters too many times in a row.

We *finally* went to a civilian doctor when we were taking leave on route to the Philippines because my parents, thankfully, lived far enough from any military hospital that the visit could be billed to the military. (He went to the doctor at the hospital near *his* folks and got the same story as at our old base... gave him some pain meds and muscle relaxants.) SO! We went to the doctor in my home-town, immediately got an MRI and stuff, the doc says... lookie, you've got three herniated disks in your lower back, I suggest traction therapy, at least to start.

Then we got on an airplane in St. Louis, and Praise God Almighty, first come first serve... the Air Force put us in first class, and my husband sat for 24 hours... if it had been in coach he'd probably be a cripple.

But we had the MRI images with us and he walked into the doctor's office at Clark and got immediate help.

Now *maybe* the doc's at Clark would have sent him to get an MRI right away too... maybe...

What we hear from Canada and what we hear from the UK is pretty similar. Waiting lists are long. Convincing someone that you're really sick is sometimes hard... sometimes not, but when it is there is limited ability to go find someone else to get an opinion from and sometimes the specialist you get sent to is the only one for your area... and you can't just decide to circumvent the system. It's not allowed.

As a thought experiment, what if government-run health care were high quality? Would that make it okay?

No, because it would bankrupt the country. Not the $2 Trillion deficit that Obama was promising before Cap and Tax and health care reform, but real serious, 25%+ of GNP dedicated to health care.

Because government health care even more disassociates price from quantity than we have now, demand is guaranteed to soar. But in that case, the government has two choices: ration or spend hugely greater amounts of GNP. You have presupposed that rationing isn't utilized, leaving huge increases in costs.

Oh, and have I mentioned that we are in the midst of probably the worst recession in the last 50 years, and raising taxes at such a time is guaranteed to significantly impair our recovery from it? Or, that the Chinese are threatening not to buy any more of our debt?

I think that one of the big disconnects here was evidenced by the President saying that one advantage of his health care plan is that (evil) insurance companies would no longer be making coverage decisions, rather, it would be the government.

What I wanted to ask him, was: Why that would be better?

What he doesn't seem to grasp is that when the government rejects your claim, you have no recourse, except through the political process. But then, when you do have recourse through the political process, you get political results, such as as much being spent on AIDS research, a disease that often has a large voluntary component, as is being spent on cancer, with 40x the death toll, and more than for heart attacks, which again have a 40x death toll.

Yes, the evil insurance companies also reject claims. But in the long run, they have far less ability to do so than the government does.

If you get your insurance through work, then if enough employees complain, next time around, your employer is likely to look closely at other companies. And if you have an individual plan, you don't have to wait until the yearly renegotiation.

All you have to do is look at the results with other countries with socialized medicine of one type or another when it comes to non-standard care. Look at how long it takes to get an MRI, or how many MRIs per million people, etc. And you can see why governments invariably resort to rationing, and that rationing invariably takes the form of limiting the more extreme (and expensive) care, and does so for those in the most need.

The one fact we know is that the goverment has failed miserably to rein in Medicare & VA costs, eliminate waste and fraud and monitor quality.

One thing to keep in mind whenever the low overhead costs for Medicare are brought up, is that such is a primary cause of the huge level of waste and fraud in the system - a level that appears to be well in excess of that of the combined overhead and fraud and abuse of private insurance plans.

I've gone from anger, to depression to near despair about this health care thing for awhile. I'm blessed with good health, touch wood, but I know as I get older that could change. What I really fear is my children's future if this legislation passes.

I would leave, but where would I go? Seriously. I do not want to live in a socialist country, and I don't think I can take the heartbreak of watching the destruction of this country.

I agree with Chip: The "crisis" comes from no one questioning that there is a crisis. Congress would rather pass a bad bill than no bill at all.

I have a low-premium, high-deductible plan with a health savings account. I pay for everything (except the usual preventive stuff) with pre-tax dollars and still pay less overall than I would with a cadillac policy. If we all had to pay cash for preventive tests--mamogram and pap, for example--those costs would come down. See what has happened to the cost of LASIK over the years.

Chip - " I believe modern life is just too complex for some people to handle and the costs are so high they need their freedom exchanged for security. Even if they had insurance, then that complexity would be too much to handle. So this rational argument about stellar health care being exchanged for freedom and sub-standard health care loses to the masses of people with no health care at all and an inability to cope with the complexities of modern life."

My Mom died of cancer. Then there was a year-long battle over medical bills, dunning notices that providers said the insurer failed to pay, hundreds of dubious hospital charges for her 6 hospitalizations in her final year...the dunning notices and high pressure collection agencies started with her, dying, trying to deal with them. Then my Dad. My Dad is a smart person, but it was the bills and conflicts between the insurers, "caregivers", specialists, and hospital(s) were overwhelming. He had to hire someone who "knew the right codes" and "prevailing practices" to challenge some charges, get the insurer to admit they (without actually admitting it) were not paying bills they should have in hopes that Dad would just fork it up.

The guy he hired said the two insurers were notorious for rejecting bills, putting people on hold for 20 minutes in hopes that they would get "sick of it" and pay themselves. He knocked 30% off the hospital bill and got retroactive discounts on some drugs and home disability materials Mom should have gotten.

Right now, it is a conflict between people who have "great corporate health insurance" - a minority in this country, and those that (1)Don't have health insurance;(2)Have inadequate or bad insurance with all sorts of "pre-existing condition, drug selection; (3)Hate the nightmare maze of medical bills and insurers they must become embroiled in; (4)Business leaders and economists that now collectively say that paying 50% more per capita than any advanced nation and adding those costs to goods we are trying to export is absolutely unsustainable.

Bruce Hayden - " As a thought experiment, what if government-run health care were high quality? Would that make it okay?

No, because it would bankrupt the country. Not the $2 Trillion deficit that Obama was promising before Cap and Tax and health care reform, but real serious, 25%+ of GNP dedicated to health care."

Hard to see how the country would be bankrupted faster by reducing medical costs to levels equivalent to what other advanced nations with higher life expectancies. That would be 50% less than we are now paying. And people in Japan, Germany, France have had 60-100 years to work out the kinks, so we DON't HAVE to take the relatively bad British plan.

2) layer upon layers of bureaucratic bullshit that did not exist 20 years ago.

The biggest item is an aging population

(Military OB/GYN departments are huge because everyone is in their prime reproductive years.) The crisis component of that force structure is that OB/GYNs start as general surgeons, so they are deployable

The only thing to consider is who is exempted: members of congress, federal employees and various union members and state employees. If it isn't good enough for them, why is it good enough for you?

yes, the various ills exempt the FEHBP from requirements. te irony is that the FEHBP is a shell of admin types that it on top of a BCBS insurance plan. you know, the evil type that will be put out of business

This is page 16 of Hr 3200. It seems to grandfather existing coverage as long as nothing in your policy changes and you dont need to change employers and thus plans.

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.(a) GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED.—Subject to the succeeding provisions ofthis section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered healthinsurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met: (1) LIMITATION ON NEW ENROLLMENT.— (A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first ef15fective date of coverage is on or after the first day of Y1. (B) DEPENDENT COVERAGE PER18MITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day. (2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.

As someone who deals with government employees working in their monopoly feifdoms nearly everyday, I see that a lot depends on those employees attitudes. With computers many things will work well unless the employees just enjoy hurting people and making life miserable for others. If they are bad government employees, then there is NOTHING you can do about the disasters that they are intentionally causing everyone. There is no competition that could easily drive these mentally ill people out of business and replace them with good people. Obama's proposed, unnecessary, government monopoly over health care may be a ploy to drain all remaining wealth out of the USA in order to defund our Military Power.

Michael Yon's blog posting on the Afghan village of Sangow Bar contains a statement very pertinent to the USA's pending health bill: "Dr. Yaqubi wants to show people that health care is not free, but he says that the parliament in Kabul thinks it should free to all. The Afghan government can’t even drill a well for this provincial hospital, and all their machines and supplies were probably donated, yet they want “free” healthcare. The beggars of Kabul who refuse to drill a well for the Ghor Provincial Hospital want free health care for all!"

Well, our President and his Democrat fellows in Congress want the USA to have health care for all, much IMHO would be free. Yet we can't take care of our own borders, use our own resources for energy, or promote our own form of freedom to others.

Chip Ahoy, tell your housekeeper to call the hospital and tell them that she can pay only X dollars per month (10, 20, whatever). They will try to get her to pay more, but tell her to be firm - stick to a number with which she is comfortable. They will urge her to put the bill onto a credit card, but she should refuse. Then she simply has to keep up the payments for as long as it takes - years, maybe. As long as she doesn't miss a payment, her credit will be fine and the hospital can't pursue her legally. It's a bit irritating, but also a great no-interest loan.

Why not just add the unisured/uninsurable to an existing government plan/program? Immediate problem solved.

Oh get real. Who the hell do you think you are offering a basic common sense approach to this very complex and important issue? /end snark

I’ll beat this horse again and say that the first step in health care reform is reforming the attitude of American society as to what constitutes health care. One of the main reasons your health insurance premiums are sky high is because we insist on paying a $20 co-pay for our health care and that’s it. Whether it’s a broken leg or an annual physical we have been conditioned to pay a measly co-pay and go on our way. Well that $20 probably covers 5% of the frickin office visit which means the insurer has to pony up the rest. I worked for a health insurer for several years and when group plans wanted lower premiums we could accommodate by reducing benefits or raising deductibles. Raise a deductible and the people pitched a fit. Take away benefits like bariatric surgery and they pitched a fit. Raise a co-pay and they pitched a fit. Fine, here’s the premium. They pitched a fit. Again, you don’t have health insurance you have a health coverage plan. Try filing a claim with your auto insurer for the oil change and tune up on your car and let me know how that works out. Try filing a claim with your homeowners insurance because you had to replace your water heater or sump pump and let me know how long the CSR laughs at you. Now the BJM makes a good point. Just add these uninsured to the Medicare rolls and offer them Part A. That way they will have inpatient and skilled nursing care. If they want basic doctor care then they can pay a Part B premium and go on from there. Now everyone has basic medical coverage and no one will have to be bankrupt because they broke an arm or gets cancer. Raise the Medicare tax on EVERYONE to 2% and required anyone who is not 65 and over who is on Medicare to pay a monthly $50 premium for Part A. There, we just solved the crisis in 5 minutes.

Am I the only person who's seen this bullshit in action, and will speak out about it? In Europe, I've walked through floor after floor of a hospital and never even encountered a nurse. What's wrong with you people? Stop this NOW.

2) layer upon layers of bureaucratic bullshit that did not exist 20 years ago.

3) An aging population (thanks to Drill SGT)

4) The leveraging effect of under-reimbursement of medical costs by Medicare and other government payers.

The way this works is that when actual costs go up - whether because labor costs are rising, government mandated overhead rises, etc., the government, for such programs as Medicare, does not increase its reimbursements accordingly. Rather, it is more likely to cut them. As a result, those covered by private plans and those (actually) paying themselves for their health care cross-subsidize the difference between costs and government reimbursements for those in those programs.

Things are only going to get worse, which may be part of why the Democrats are so hot to trot getting everyone under government plans. Doctors are bailing right and left from taking Medicare, etc. patients. Meanwhile, the Obama Administration has done almost anything that it thought it could to bail out all those zero down housing borrowers by inflating the value of their houses through its economic policies (esp. the two trillion dollar deficit and all the borrowing that requires).

So, every time that a medical cost goes up, whether due to minimum wages going up, new drugs coming onto the market, etc., those with non-government paid health care are paying for not only their own part of the increase, but also for the increases of those on Medicare, Medicaid, etc.

Of course, just to make this problem worse, this is the time that Medicare decides to (proudly) CUT its reimbursement rates, claiming cost savings as a result. Yes, it cut its own costs - by making everyone else pay just that much more for those covered by Medicare through this cross-subsidization.

2. If you have you'll realize that most Europeans that have not been to America don't know how good we have it here, so they don't complain about how they have it there.

True. No Western European has ever gone through anything like Cedarford's mom's experience -- if they knew what it was like they'd never complain about their health care.

2.a. They don't have as high of standard of living as we have here - not even close

I've been thinking about my cousins. They live in an apartment instead of a house -- but they think American wood framed houses are shacks; vacation cottages at best. They only have one car -- but the suburban rail station is only two blocks away. Their plasma screen is only 50 inches. They only get 30 channels on the cable. The high cost of electricity means while they have a washer, a dishwasher, and a freezer, they have no drier. For fun, they ride their bicycles. The net result is that my cousin at 60 has the thighs and butt of an 18 year old.

I've been thinking about my cousins. They live in an apartment instead of a house -- but they think American wood framed houses are shacks; vacation cottages at best.

And so they continue to pay rent to someone else, because their high cultural standards demand that they build bomb shelters for homes, and nobody but the very rich can afford them.

They only have one car -- but the suburban rail station is only two blocks away.

And so their unemployment rate chronically runs 4 to 5% higher than the normal US rate because the train line into the village doesn't pay for itself and the rest of the country is taxed to keep it running.

I've been thinking about my cousins. They live in an apartment instead of a house -- but they think American wood framed houses are shacks; vacation cottages at best.

Sounds like they a)have a very limited exposure to the US or b) elitist snobs who think homes should be chateaus or nothing at all or c) all of the above.

I pick C

As an aside, for all the hoopla about how friggin great Europe is, I don't see mucn in the way of a mass exodus of Americans moving to France, Germany, England, etc. I've been there and I think its nice and if I had to live there I think I could assimilate much easier than say Brazil or say, Uganda. However, I still think that for all its faults life here is still better.

"unless the employees just enjoy hurting people and making life miserable for others."

Bingo. Bureaucrats are monsters. I worked in the public sector in my younger, idealistic years, so I know the mindset- which is, do whatever you can to avoid work. If that means not returning calls or throwing more paperwork at customers, so be it.

People will die rather than deal with these assholes.

The idea that you can get high quality healthcare for everyone on the cheap is a liberal wetdream. Quality costs. Especially due to administrative overhead. Replacing the private insurance bureaucracy with a public one will COST MORE. Basic rule of economics: the public sector has zero incentive for efficiency.

Pay as you go for basic healthcare care is the way to go. Catastrophic coverage for major illness. Like other types of insurance. Lower overheads lower costs.

But most Americans see health care as an entitlement that the govt. should provide, at low cost to them. So we will end up with an inefficient, bureaucratic nightmare and still get sick.

With today's system, yeah you better have money if you get seriously sick, or your health care will be shit and you will likely die. Under Obamacare, EVEN if you have money, if you get seriously sick your health care will be shit and you will likely die. That's called equality.

"If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price."

Bullshit.

There's a good reason we're the ONLY industrialized nation on the planet without national health care for it's citizens: The Insurance Lobby.

*Except of course for those who are well taken care of via Veterans Benefits, Medicare and Medicaid...all nasty "socialistic" programs people here whine about on a daily basis.

I've asked before and never really get a reasonable response, but can I assume Ann and the rest of the wingnut pack here will refuse all benefits provided by those "socialistic" programs when the time comes...or will you agree to stop right now if you're already eligible?

So, we'll now have to bow down to f'ing bureaucrats in order to go to the store, to drive over the hills to Grandma's hovel, to buy APCs from the pharmacy, to move to the next village/department, to even stay in our own homes/houses/hovels unless the f'ing bureaucrats approve. And, of course, our local bureaucrat will be an elite who knows better than us mere peasants.

Very stupid. The US is not like Canada. It's not like the UK. It's not like France, Australia, Sweden or Japan. In fact, its not like anywhere else on earth. We are a unique nation and require a unique approach. Let's stop pretending we can simply choose among the health care delivery systems operating elsewhere and just transfer it here with an expectation of the same approximate results and without significant harm to our hallmark R&D.

"We're MUCH better than those other silly countries that existed for centuries before us.

What could THEY possibly know that WE don't know?

Could you possibly be more arrogant?"

Nope. Arrogant up the fucking whazoo we are! Could you possibly be more pussy?!? Where do you think you are, Thailand?!? What is your major malfunction? That an American can be as proud of his country as those arrogant pricks are of theirs? Ever heard a Frenchman say "Viva la France!" and another come along and say, "What the hell are you talking about?" - no! - only liberal American assholes say that kind of shit. France, Germany - all of 'em - can be as proud as they want but it's demanded, even by some Americans like you, that we cower and be humble before the rest of 'em. Well fuck you. We have standardized toilets, fool - something those "other silly countries that existed for centuries before us" can't seem to figure out yet! Why is that? Are they stupid? That would seem like a major "quality of life" issue, right? What gives? And their health system SUCKS - I lived there, so don't give me no bull about what you fucking "believe" they're doing! You want some European-style medicine? Then turn on the fucking tap and get some smartguy! Why haven't "other silly countries that existed for centuries before us" figured out water ain't medicine, idiot? You - and they - are a fucking joke and, yea, I'll be as fucking "arrogant" as I want about NOT being in the anti-American clique you pussies share together! Fuck you! It was living over there that taught me everything I need to know about my home and, damn it, people like you really should get the fuck out if you don't like our country - or our arrogance - because you need a dose of the reality of those "other silly countries that existed for centuries before us" to get that same perspective. Love it or leave it, bitch, and if you love it, then grow a pair to go with it.

Why can't you get it though your head: they're jealous of us! And they're using your stupid punk ass to bring us down! Ever heard the phrase "useful idiot"? That's you! It should be stamped on your forehead for calling another American arrogant in defense of Europe! We didn't try to conquer the world - that was Germany and Italy - and the french collaborated with them, just in case it worked out (You never know, right? They kicked their ass!) ! We don't have a world-wide reputation for rudeness - that's France! All those "other silly countries that existed for centuries before us" have been bested by one that's only been around for under three hundred years! That's the equivalent of being outsmarted by babies! But we're supposed to learn something from racist, backwards, stubborn, stupid, them? Give me a fucking break!

I swear, you idiots are fucking going down, and, if I have anything to do with it, when you fall your dumb ass will never get up again because I will personally chop you off at the knees because that is The Macho Response.